This invention relates to the use of various naturally occurring compounds to treat the symptoms of diseases, and, more particularly, to the use of the natural product indole-3-methanol and related compounds to alleviate the symptoms associated with premenstrual syndrome and menopause.
Premenstrual syndrome (xe2x80x9cPMSxe2x80x9d), a chronic complaint of a substantial percentage of women between the ages of 12 and 50, manifests in symptoms before and during menses. The symptoms include pain, marked general tension, marked irritability, anxiety, depression, abdominal bloating, swelling of subcutaneous tissues, nausea, fatigue, painful swelling of the breasts, headaches, dizziness, and palpitations. J. T. E. Richardson, xe2x80x9cThe Menstrual Cycle, Cognition, and Paramenstrual Symptomatologyxe2x80x9d, Cognition and the Menstrual Cycle(Springer-Verlag 1992). While virtually all women experience pain at the onset of menstruation, many women also experience some of the listed symptoms several days before the onset of menses. The symptoms vary from one menstrual cycle to another, and vary considerably among individual women. These symptoms are generally conceded to be related to the release of various hormones, including estrogens.
For women who experience severe PMS, there is considerable desire for their pain and suffering to be relieved. Some women find that their cognitive abilities are impaired and hope for ways to improve their cognitive performance during the days when affected by PMS. Id.
Studies have revealed that during PMS, some women develop xe2x80x9cfood cravingsxe2x80x9d which adversely affect some aspects of their health. J. J. Rapkin and D. Tonnesses, A Woman Doctor""s Guide to PMS, (Hyperion, 1994). Generally, these patients are directed to eat regular small meals, decrease their intake of salt, fat, sugar, and caffeine, and increase consumption of whole grains, seed and nuts, vegetables, fruits, and vegetable oils. In addition, vitamins and dietary supplements such as primrose oil are sometimes used by women to alleviate the symptoms of PMS.
Menopause, or xe2x80x9cthe change of lifexe2x80x9d, occurs when a woman""s cycle of ovulation and menses ends. Common symptoms of menopause include hot flashes, excessive sweating, vaginal atrophy, and sleep disturbances. Menopause is a natural consequence of aging caused when a woman""s ovaries begin to produce less estrogen. It is widely accepted that the symptoms of menopause result from decreased estrogen in the body. I. Schiff, Menopause (Times Books, a division of Random House, 1996). It is often acknowledged that the manifestations of menopause can be alleviated by controlling the diet. For example, it has been observed that women in Japan and China have decreased menopausal severity compared to women in Western countries. In most texts, this is attributed to the consumption of soy products. However, it must be recognized that Asian women also eat substantial amounts of cruciferous vegetables in addition to soy products. The possibility that menopausal symptoms result from changes in estrogen metabolism is seldom mentioned.
Beginning in the 1960""s, many symptoms of menopause have been dealt with through estrogen supplementation. B. Kass-Annese, Management of the Perimenopausal and Postmenopausal Woman (Lippincott, 1999). More recently, other hormones, such as progesterone, have been employed. Other steroids have been suggested, along with numerous medications, to relieve various symptoms. While many studies have investigated the various hormones which might be taken by various means, little research has been done to investigate the ways in which hormones, particularly estrogens, might be metabolized to alter their physiological effects. 1H-indole-3-methanol (CAS Registry Number [700-06-1]) is a naturally occurring product which is derived from cruciferous vegetables. It is known to exhibit substantial effects in the metabolism of estradiol as reported by many workers, and has been implicated as having potential utility in the treatment of breast cancer. In this regard, one of 1H-indole-3-methanol""s pharmacological activities is that of an estradiol 2-hydroxylase inducer. Some of its effects have been summarized in a review by Michnovicz and co-workers. Michnovicz et al. xe2x80x9cChanges in Levels of Urinary Estrogen Metabolites After Oral Indole-3-Carbinol Treatment in Humansxe2x80x9d, J. Nat""l Cancer Inst., 89(10):718-23 (1997). It has also been observed that 1H-indole-3-methanol reacts with itself in stomach acid and under other conditions such as heat, light and even water solutions to form new compounds (xe2x80x9c1H-indole-3-methanol compoundsxe2x80x9d). See, e.g., Michnovicz and Bradlow, xe2x80x9cDietary Cytochrome P-450 Modifiers in the Control of Estrogen Metabolismxe2x80x9d, Food Phytochemicals for Cancer Prevention I, Fruits and Vegetables, pp. 282-293, nn. 89-93, edited by Mou-Tuan et al. ACS Symposium Series 546 (American Chemical Society, Washington, D.C., 1994). Some of these 1H-indole-3-methanol compounds (e.g., diindolylmethane and indolo(3,2-b)carbazole) are reported to bind the same receptors as the 1H-indole-3-methanol. Id.
Although described for the potential treatment of breast cancer and fibromyalgia (see, e.g., U.S. Pat. No. 5,895,787 to Arffmann et al. (Apr. 20, 1999), heretofore, the use of 1H-indole-3-methanol compounds for treating conditions such as PMS and hormone related difficulties associated with menopause is not believed to have been described.
Dietary indoles, particularly, 1H-indole-3-methanol, have been found to greatly relieve the symptoms of premenstrual syndrome (PMS) and menopause. Patients with PMS have reported decreased menstrual cramping, decreased menstrual flow, shorter duration of menses, decreased fatigue, less frequent headaches, improved mood, and decreased bloating resulting from the oral administration of pharmaceutically effective amounts of dietary indoles derived from 1H-indole-3-methanol. Positive results were sometimes seen within one menstrual cycle of using daily doses of 1H-indole-3-methanol compounds. Patients suffering from menopause have reported considerable reductions in hot flashes and sweating profusion and less sleep disturbances resulting from the oral administration of pharmaceutically effective amounts of dietary indoles derived from 1H-indole-3-methanol.
The invention thus includes a method of treating PMS in a patient believed to be suffering therefrom, the method comprising: administering to the patient an 1H-indole-3-methanol compound in a medically acceptable manner in a pharmaceutically effective amount on a daily basis or during a specific portion of the menstrual cycle, such as days 7-21 after menses.
The invention also includes a method of treating menopause in a patient believed to be suffering therefrom, the method comprising: administering to the patient an 1H-indole-3-methanol compound in a medically acceptable manner in a pharmaceutically effective amount on a daily basis.
The invention also includes methods of making a pharmaceutical compositions containing an 1H-indole-3-methanol compound or compounds for use in the treatment of menopause or PMS.
1H-indole-3-methanol compounds are naturally occurring compounds. These dietary indoles result from the maceration of cruciferous vegetables by the manner briefly described herein. Glucosinolates, a set of compounds containing a glucose component, a sulfur-carbon-nitrogen component, and a variable component, occur in varying ratios in varietals, leaves, stocks, stems, flowers, seeds, and roots of the brassica (or crucifiers) plants. For example, in glucobrassicin, a glucosinolate, the variable component is 3-indolylmethyl. When the cell walls of the plant are destroyed through chopping, grinding, chewing, for example, an enzyme, myrosinase, is released. Myrosinase aids in the hydrolysis of glucobrassicin resulting in the release of 1H-indole-3-methanol, often called indole-3-carbinol. 1H-indole-3-methanol is produced in sufficient quantity that it can be isolated from the juices of many of the cruciferous vegetables such as, for example, cabbage, Brussels sprouts, or broccoli. It has also been shown that 1H-indole-3-methanol can be produced from indole by any of a number of chemical transformations.
Whether derived from cruciferous vegetables or prepared by one of a number of controlled chemical transformations, 1H-indole-3-methanol is a very reactive molecule, unless it is kept cool, dry, and isolated from species with which it easily reacts. 1H-indole-3-methanol is especially reactive with hydroxyl groups.
1-indole-3-methanol will react with ascorbic acid to give ascorbigen, so named because it was once thought to be the origin of ascorbic acid (vitamin C) in cruciferous vegetables. Later studies showed that vegetable juice showed a decrease in ascorbic acid upon standing due to the combination of ascorbic acid with 1H-indole-3-methanol. As previously indicated, 1H-indole-3-methanol has been studied extensively in connection with cancer prevention. It is also used as a dietary supplement to aid in the inhibition of laryngeal papillomatosis.
Numerous studies have shown that four other compounds: a carbazole, namely, indolo[2,3,-b(carbazole)]; a xe2x80x9cdimerxe2x80x9d, bis(3-indolyl) methane; a linear xe2x80x9ctrimer,xe2x80x9d namely 2-(indol-3-ylmethyl)-3,3xe2x80x2-diindolylmethane; and a cyclic xe2x80x9ctrimer,xe2x80x9d namely 5,6,11,12,17,18-hexahydrocyclonona[1,2-b;4,5-bxe2x80x2;7,8-bxe2x80x3]triindole also result from the reactions of 1H-indole-3-methanol with itself. These four additional identified products are only a sampling of the products realized by heating 1H-indole-3-methanol.
It has been shown that the same array of products results from subjecting the 1H-indole-3-methanol to stomach acid, or even acidified water. Consequently, numerous workers have concluded that the mixture of dietary indoles (the xe2x80x9c1H-indole-3-methanol compoundsxe2x80x9d), not just 1H-indole-3-methanol, is responsible for the beneficial effects seen in providing animals and humans with dietary indoles. In fact, cell tissue studies have led workers to conclude that 1H-indole-3-methanol may not be beneficial at the cell level, but that some other derivative, such as the xe2x80x9cdimer,xe2x80x9d the xe2x80x9ctrimers,xe2x80x9d the carbazole, and/or perhaps other compound(s) in the dietary indole mixture, is/are the actual entity/entities giving beneficial results.
Whether 1H-indole-3-methanol is derived from the extraction of cruciferous vegetables or is prepared by a chemical reaction in which indole is a starting material, it will result in identical chemical products when ingested by humans. Since 1H-indole-3-methanol is reactive, and positive results are obtained in other applications with the reaction products of 1H-indole-3-methanol, it is believed that not only 1H-indole-3-methanol, but its reaction products, will be effective in mitigating the symptoms of PMS and menopause. This family of indole-containing compounds, including 1H-indole-3-methanol and products derived from the reaction of 1H-indole-3-methanol with itself, are called dietary indoles. The reactive nature of 1H-indole-3-methanol is an important consideration in this invention.
Preferably, the 1H-indole-3-methanol compound used to practice the invention is selected from the group consisting of 1H-indole-3-methanol; ascorbigen; (3-indolyl) methane; indolo[3,2-b(carbazole)]; 2-(indol-3-ylmethyl)-3,3xe2x80x2-diindolylmethane; 5,6,11,12,17,18-hexahydrocyclonona[1,2-b;4,5-bxe2x80x2;7,8-bxe2x80x3]triindole; 1H-indol-3-yl methoxy methane; ethoxy 1H-indol-3-yl ethoxy methane; other ethers of 1H-indole-3-methanol, and mixtures of any thereof. Also included within the scope hereof are pharmaceutically acceptable esters of the 1H-indole-3-methanol compounds. Once the 1H-indole-3-methanol compound or compounds has/have been chosen, methods and compositions for making dosage units containing the compounds are well-known to those of skill in the art. For instance, conventional techniques for making tablets, capsules, and pills containing active ingredients are described in the standard reference, Chase et al., Remington ""s Pharmaceutical Sciences, (16th ed., Mack Publishing Co., Easton, Pa., USA, 1980) (xe2x80x9cRemington""sxe2x80x9d) at pages 1553 through 1584. Conventional techniques for making powders, and their composition, are described at pages 1535 through 1552 of Remington""s. Conventional techniques for coating pharmaceutical dosage forms are described at pages 1585 to 1593 of Remington""s. 
For making dosage units, e.g., tablets or capsules, the use of conventional additives, e.g., fillers, colorants, binders, and the like is contemplated. In general, any pharmaceutically acceptable additive which does not interfere with the function of the active compound can be used in the compositions.
Suitable carriers with which the compositions can be administered include lactose, starch, cellulose derivatives and the like used in suitable amounts. Mixtures of carriers can also be used.
A process of manufacturing a composition for oral administration of the invention includes mixing predetermined quantities of the active ingredient with predetermined quantities of excipients and converting the mixture into dosage units containing, for example, 5 to 1000 milligrams (xe2x80x9cmgxe2x80x9d), preferably 25 to 400 mg, of active ingredient.
Converting the mixture into dosage units generally involves molding the mixture into a tablet, filling a capsule with a dry mixture, or filling a capsule with a wet mixture.
Once made, the dosage units may be administered daily or during a specific portion of the menstrual cycle, for example 7-21 days after menses, to achieve the desired dosage.
Although generally less desirable from a patient acceptability view point, the active ingredient may alternatively be parenterally administered in dosages equivalent to the oral dosages described herein (taking into consideration effects such as bioavailability), such as by injection or transdermal delivery.